Periodontics

SeminarSubmitted by,

Arya V DeviCRRIRajas Dental College

Topic:

Sonic & Ultra Sonic Instrumentation

Key ConceptKey Concept

Combination of hand

Instrumentation and

mechanized

instrumentation is

probably most effective,

clinically and in terms of

time management.

Types

PowerInstrumentation

Sonic Instrumentation

MagnetostrictiveUltrasonic

Piezoelectric Ultrasonic

Sonic Scalers

Tip rotates with circular

tapping motion-all sides of tip effective

Minimal heat

generated-needs water

Inexpensive ($600-800)

NoisyPortable

Sonic Scalers

Dental EZ-

Titan

Implant

tip

KaVo

Parts of an Ultrasonic Device

Ultrasonic scaler

Parts Of Ultrasonic

Scaler

Piezoelectric scalerCrystal quartz

converts electrical

energy into mechanical vibrations.

Linear tip movement-sides only

effective ie, vibration is

linear

Most expensive of

all the mechanical

scalers

Light and quiet.

Generates heat-needs

water.

Piezoelectric scaler

Magnetized metal stacks

convert electrical

impulses into mechanical vibrations

Generates the most heat-

water is critical to degree of cooling

20,000-45,000 cps.

Elliptical motion-all

sides of tip effective

Magnetostrictive Scalers

Magnetosrictive Scaler

Magnetostrictive Power Dispersion To Tip

#1 point of tip

#2 concave surface

#3 convex surface

#4lateral surfaces

Most effective

Least effective

Ultrasonic Terminology

Power Frequency

Water Terminol

ogy

PowerPOWER refers to the electrical energy in the handpiece used to generate insert movement.

The “Power” knob adjusts the stroke

Stroke is the distance the insert moves during one cycle.

Amplitude is equal to one half the stroke.

Lower amplitude/stroke/power is generally more comfortable for the patient.

Frequency

FREQUENCY is the number of times per second the insert tip moves back and forth

during a cycle

A cycle is one complete

linear,circular or elliptical stroke path.

Frequency is set at the manufacturer

Water Terminology

• CAVITATION refers to the formation of bubbles in oral liquids/creation of shock waves in fluids• ACOUSTIC STREAMING refers to fluid movement caused by ultrasonic waves•ACOUSTIC TURBELENCE is created when the movement of the tip causes the coolent to accelerate producing an intensified swirling effect. • LAVAGE refers to flushing of the sulcus; disruption of plaque biofilm, and removal of necrotic tissue and blood

Advantages

Increased efficiency

No need to sharpen

Less chance of repetitive

strain injuries

Reduced lateral

pressure required

Water lavage and irrigation

Biofilm disruption

Disadvantage

s

Difference Manual scalerUltrasonic

Scaler

Safety Facemask, Gloves

Facemask,gloves,safety glasses

Irrigation medium/ Coolant

Antimicrobial irrigants

(Chlorhexidine, iodine solution)

Water

Calculus removal on multi-rooted

teetha) Efficiency

b)treatment time

Less efficientLonger

More efficientLesser

Precautions

Pacemaker

s

Communicable

Diseases

Imunosuppression

ChildrenDemineralized Tooth Structure

Hypersensitive Areas

Veneers,cast Crowns

And Implants

Chronic pulmonary

disease

Dysphagia or

swallowing difficulty

with water flow

Cardiovascular

disease with

secondary pulmonary

disease

Ultrasonic Inserts

Roll the insert in your fingertips for easier and more efficient scaling

Freedom @ ur Finger Tips

Slimline Straight Left Curve Right Curve

Focus Spray internal waterUsed subgingivally for all depositsLower power

Types

Straight Slim(perio) Insert /Tip

Curved Slim(perio) Insert / Tip

Use thin tip designs on low to medium power settings for efficient scaling and patient

comfort

#10 Universal # 100 Thin # 1000 Triple

1mm loss on tip (blue line)

25% loss of efficiency

Tip WearTip wear is critical to efficiency of the instruments.

2mm loss on tip (red line)

50% loss in efficiency (throwout)

Ultrasonic Set-Up

Attach handle or sheath

Step on rheostat to bring water

bubble to top of sheath opening

Flush water line for 2 minutes at the beginning of

the day (30 seconds between patients)

Push ultrasonic insert into the handle/sheath

Adjust water and power

levels

Clinical Debridement ProcedureAntimicrobial rinse- Peridex

(Chlorhexidine

gluconate 0.12% oral rinse) or Listerine

Sonic/ultrasonic (60-70%

time)

Hand scalers (20-30% time)

Sonic/ultrasonic (final 10%

time)

Selective polishing Flossing

Oral Hygiene

Instructions

Antimicrobial rinse

Working Tips

Use probing depths

and radiograp

hs as guides for ultrasonic activation

Use “Painting” strokes/Ta

pping Strokes for large deposits

Keep insert

moving at all times

Use light lateral

pressure

Work from coronal areas

apically to root

surfaces

Control water -

Use saliva ejector or

HVE to control

aerosols

Desensitizing

agents are

available for soft

tissue and dentin comfort

Vertical Strokes Horizontal Strokes Oblique Strokes

Thoroughly Cover All The Tooth Surfaces

Working Stroke Multi -Directional

Oblique • Similar to bladed

instrument• Recommended for

supragingival & interproximal

instrumentation• May limit access to

depth of pocket

Vertical Similar to periodontal

probeRecommended for

subgingival instrumentation; may

also be used supragingivally

Maximizes access to depth of pocket

Systematic approach to use

Posterior Sequence Ultrasonic Adaptation

Curved Inserts/ Furcation Adaptation

Anterior Sequence Ultrasonic Adaptation